I’m a member of the Berkeley Free Clinic and one of the individuals coordinating our community response to hepatitis A. I’ve been spending the past few months doing vaccination and education in homeless encampments and I want to clear up some inaccurate information in Angela Yip’s recent article about the hepatitis A outbreaks among homeless Californians.
For folks who are unfamiliar, the hepatitis A virus, or HAV, causes acute liver inflammation. The virus is self-limiting, meaning it resolves without medical treatment, usually within several weeks. Although HAV is unpleasant, causing abdominal pain, fatigue, nausea/vomiting and jaundice, it is rarely fatal in healthy people. The individuals who have died of hepatitis A during the current outbreaks in California were generally people who already had chronic liver problems. Overall, cases have been confined to homeless communities (there have been no outbreaks among housed people), and there have not been any cases in Berkeley.
Although hepatitis A has not reached Berkeley, the Berkeley Free Clinic and the Berkeley Public Health Division are doing vaccination outreach in the homeless community to prepare for this possibility. However, there is a nationwide vaccine shortage, and we are prioritizing homeless individuals and their sex partners. Homeless UC Berkeley students are welcome to come to the Berkeley Free Clinic to get immunized, but anyone else will have to go to their primary care provider. Note that many UC Berkeley undergraduate students have been immunized already — the HAV vaccine was added to California’s childhood immunization schedule in 1999, and immunity lasts for about 25 years.
It is unlikely that the average housed Berkeley resident will contract HAV even if it does come to Berkeley. HAV is spread through the fecal-oral route. Most people get HAV either from touching contaminated surfaces and then putting their hands in their mouths or from eating food prepared by someone with HAV. Oral-anal sex (also known as rimming) can also spread it, but the majority of cases are prevented by basic sanitation.
Although Yip refers to hepatitis A as a “waterborne virus,” this is only true in countries that don’t have water treatment facilities. Bathing in the same fountain as an infected person and swallowing some of the water might be a risk, but this behavior is easy to avoid if you have access to a private space to bathe. Likewise, “physical contact” might be an issue if you have poor handwashing habits, but in general, casual contact such as hugging does not spread HAV.
Even people like me, who interact with the homeless in a clinical context, are not considered at risk for HAV. Drug use also does not spread HAV — a lot of folks who use injection drugs are getting HAV because drug use is a marginalized behavior. Many people who inject drugs are homeless or have close contacts who are homeless, and so they are exposed to the same risk factor of poor access to sanitation.
It’s important to emphasize that the root of this hepatitis A epidemic is lack of access to toilets and clean water. However, given the punitive attitude of the city of Berkeley towards the homeless, we want to be delicate about how we discuss this issue. What we don’t want is temporary port-a-potties and handwashing stations that are taken away once the HAV epidemic is declared over — people need consistent access to sanitation and housing, or disease outbreaks will happen over and over again. We also don’t want to portray the homeless encampments as “breeding grounds” for disease in a way that blames marginalized people for their own poor living conditions — this kind of language perpetuates fear and disgust, which are emotions that already run high during infectious disease outbreaks.
Finn Black is a member of the Berkeley Free Clinic.